The Trump administration has announced a significant update to Medicaid eligibility, requiring all recipients to complete at least 80 hours of work, community service, or education each month. The move, part of the “Working Families Tax Cut” legislation, is expected to bring Medicaid in line with other federal assistance programs and aims to reduce fraudulent claims, increase personal responsibility, and ensure long-term sustainability of Medicaid and the Children’s Health Insurance Program (CHIP).
These new requirements will affect millions of Americans, with states tasked to implement the changes by January 1, 2027. While some states had already put similar requirements in place, the federal mandate extends the measure nationwide, creating new challenges and opportunities for both Medicaid enrollees and the government.
Medicaid Overhaul: Aimed at Work and Community Engagement
The new Medicaid rules are a major shift in the administration’s approach to healthcare for low-income Americans. According to the Centers for Medicare & Medicaid Services (CMS), recipients will need to complete at least 80 hours of work-related activities per month to maintain their eligibility. These activities can include a job, community service, volunteering, or educational programs. The federal agency emphasizes that these measures are designed to help working-age, able-bodied adults connect with employment opportunities and strengthen their long-term financial independence.
The changes are part of broader efforts to reduce improper Medicaid enrollment. By implementing work and community service requirements, CMS aims to decrease fraudulent claims and align Medicaid more closely with other public assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF), which have similar policies in place. Health and Human Services Secretary Robert F. Kennedy, Jr. has expressed support for the new guidelines, arguing that they will help recipients “live healthy and fulfilling lives” while also promoting financial independence.
However, critics of the policy warn that the new reporting requirements may create unnecessary barriers for low-income individuals to remain on the program. The additional administrative burden of proving compliance with the work requirements could result in eligible individuals losing their benefits, especially those with unstable employment or limited access to resources for tracking and verifying their hours.
State Flexibility and Implementation Challenges
While the federal government is mandating the new rules, states will have some leeway in how they implement them. CMS has provided states with $200 million in fiscal year 2026 to establish the necessary systems for verifying community engagement activities and ensuring compliance. States also have the option to require recipients to demonstrate engagement for one, two, or three consecutive months before January 1, 2027.
This flexibility is intended to allow states to tailor their implementation strategies to their specific needs, but it also creates a patchwork of rules that may differ widely across the country. According to Dr. Mehmet Oz, CMS Administrator, the goal is to ensure that states balance the benefits of flexibility with the need for efficiency, particularly in terms of system costs and operational burdens. States are encouraged to align their new policies with existing regulations for other public benefits to streamline processes and reduce costs.
